I have been experiencing severe pain in my left hip radiating down to my foot. Its gotten progressively worse and i suspected a muscle or hip problem. After finding no relief with PT, exercising and massages I decided to try a chiropractor to adjust me....My first time with one.

He x-ray'd my back and informed me i have a transitional vertebrae that is fused to the sacrum on the right side. he suggested I see a back doctor. I went to a well known spinal surgeon in the Bay Area and he ordered an MRI. The report just came in and here is what it says.

FINDINGS:
At the edge of the field-of-view on transaxial T2 weighted images there is apparent inhomogeneous
increased signal intensity within the left iliac bone extending to the sacroiliac articulation. The findings
could be artifactual in nature due to the fact of the images were obtained at the edge of the field-of-view
but could indicate ongoing osteitis or stress reaction. An MRI of the sacrum, iliac bone and sacroiliac
articulations right be useful for further evaluation if clinically indicated.
There are no intrinsic abnonnalities at the level of the conus medullaris or cauda equina.
Overlying the left L4-L5 facet joint there is a well-circumscribed fluid-filled cyst measuring 12mm in
vertical span and 6 mm in greatest cross-sectional diameter. The fmdings are compatible with a ganglion
cyst most likely arising from a wide fluid-filled facet joint on the left side at the L4-L5 level. The ganglion cyst contributes to moderate to mark left-sided lateral recess encroachment and impression upon
the thecal sac on the far left side.
No significant disc disease is identified at any lumbar disc leveL At the L4-L5 level there is mild diffuse
disc bulging without clear evidence for annular tear and without evidence for hemiation. No large
herniation or transligamentous disc extrusion is identified at any lumbar disc leveL
There is no evidence for osseous infection, osseous tumor or significant ve~tebral body compression
deformity from the T12 through the S2 levels

IMPRESSION:
I. At the edge of the field-of-view, on transaxial T2 weighted images there is apparent inhomogeneous
increased signal intensity within the left iliac bone extending to the sacroiliac articulation. The findings
could be mtifactual in nature due to the fact that the images were obtained at the edge of the field-of-view.
However based on the images provided, osteitis and/or stress reaction cannot be excluded. For this reason
an MRI of the sacrum and iliac bones may be useful for further evaluation if clinically indicated.
2. Overlying the left L4-L5 facet joint there is a well circumscribed fluid-filled cyst measuring 12 mm in
vertical spa11 a 6 mm in greatest cross-sectional diameter compatible with a gm1glion cyst most likely
arising from a wide t1uid-filled facet joint on the left side at the L4-L5leveL The presumed ganglion cyst
contributes to moderate to marked left-sided lateral recess encroachment at the L4-L5 level on the left
side.
3. No significant disc disease is identified at any lumbar disc leveL

Please help me understand this report. My Dr had his assistant call me as he is in surgery today to inform me I have a cyst in my back but he has not seen the films yet and he will follow up with me on monday.

The PA was giving you the highlight of your MRI, and the probable cause of your pain. The cyst is located at the L4-L5 segment and [B]contributes to moderate to marked left-sided lateral recess encroachment at the L4-L5 level on the left[B]. It is described as a ganglion cyst, which makes sense as it is growing at the facet joint.

The facet joints are the synovial joints located at each vertebra that allow the spine to bend, extend and twist. They are subject to degenerative and arthritic changes, just as the other synovial joints like the hip, knee or ankle.

Ganglion cysts are fluid-filled, benign sacs that form over the joint capsule or tendon sheath, most commonly in the wrists, hands or feet. They can develop slowly over time or can come on suddenly, and obviously, can form over any joint in the body. Usually they do not cause pain, except when they are pressing on a nerve...which is what is going on in your case. The cyst is pushing out into the lateral recess and pushing on the thecal sac, which contains the spinal nerves, as they bundle together to form the cauda equina.

When a nerve is irritated or compressed, pain can be felt anywhere along the path of the nerve...the L4 and L5 nerves run out toward the hip and down the leg...(you can look for a "dermatome map" online to see the approximate area that each nerve innervates),

The disc at this level is also identified as bulging...which is the first stage of development...it is not herniated and there is no annular tear.

Otherwise, the discs look go and there is no sign of degenerative disc disease at the other levels.

So, other than the cyst, the lumbar area looks good. Since this is causing you pain, my guess is that the surgeon will want to do something about it --what, I couldn't say...perhaps they can stick a needle into it and drain the fluid, or it can be surgically removed. Maybe they can give you a steroid injection that will dry up the fluid in the cyst....

The other issue that is first mentioned may or may not be a problem. There was something out of the ordinary showing on the edge of the iliac bone where it joins the SI joint on the left side. (I believe this is something unrelated to that transitional vertebra....) But it may just be a visual distortion due to this area being on the edge of what the MRI picked up. The radiologist is suggesting that this area be examined further to rule out a meaningful "finding." [B]An MRI of the sacrum, iliac bone and sacroiliac articulations might be useful for further evaluation if clinically indicated.[/B] These further tests should be done as the imaging looks like there could be an issue with osteitis, which is swelling or inflammation of the bone. Again, this is noted on the LEFT side and very well could be contributing to the pain that you are feeling in your left hip, etc.

Remember that none of us are doctors, so keep that in mind. as you read on the board. I believe the above to be correct but you will need to see your surgeon for an accurate analysis of your issues.

Good luck. I hope you will be able to get your pain issues resolved soon.